Comparison of the Detection Rates of RT-PCR and Virus Culture Using a Combination of Specimens from Multiple Sites for Enterovirus-Associated Encephalomyelitis during Enterovirus 71 Epidemic

Tsai, Jeng-Dau; Tsai, Henry J.; Lin, Tsai-Hsiu; Chang, Yuan Yen; Yang, Sen; Kuo, Hung-Tsung

doi:10.7883/yoken.67.333

Cited by 11 publications

(6 citation statements)

References 29 publications

(38 reference statements)

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“…Although CSF testing is usually positive in enterovirus aseptic meningitis, it is frequently negative in EV71-associated neurological disease, including encephalomyelitis. 3,17,[38][39][40] The present study established that, despite high rates of CNS involvement, EV71 was infrequently identified from CSF specimens, while throat, stool, or rectal swabs had high diagnostic yields. Viral load in the CSF may be low in contrast to continued viral shedding that occurs from the gastrointestinal tract for several weeks after clinical recovery.…”

Section: Discussionsupporting

confidence: 62%

Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children

et al. 2016

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IMPORTANCE Enterovirus 71 (EV71) causes a spectrum of neurological complications with significant morbidity and mortality. Further understanding of the characteristics of EV71-related neurological disease, factors related to outcome, and potential responsiveness to treatments is important in developing therapeutic guidelines. OBJECTIVE To further characterize EV71-related neurological disease and neurological outcome in children. DESIGN, SETTING, AND PARTICIPANTS Prospective 2-hospital (The Sydney Children's Hospitals Network) inpatient study of 61 children with enterovirus-related neurological disease during a 2013 outbreak of EV71 in Sydney, Australia. The dates of our analysis were January 1, to June 30, 2013. MAIN OUTCOMES AND MEASURES Clinical, neuroimaging, laboratory, and pathological characteristics, together with treatment administered and functional motor outcomes, were assessed. RESULTS Among 61 patients, there were 4 precipitous deaths (7%), despite resuscitation at presentation. Among 57 surviving patients, the age range was 0.3 to 5.2 years (median age, 1.5 years), and 36 (63%) were male. Fever (100% [57 of 57]), myoclonic jerks (86% [49 of 57]), ataxia (54% [29 of 54]), and vomiting (54% [29 of 54]) were common initial clinical manifestations. In 57 surviving patients, EV71 neurological disease included encephalomyelitis in 23 (40%), brainstem encephalitis in 20 (35%), encephalitis in 6 (11%), acute flaccid paralysis in 4 (7%), and autonomic dysregulation with pulmonary edema in 4 (7%). Enterovirus RNA was more commonly identified in feces (42 of 44 [95%]), rectal swabs (35 of 37 [95%]), and throat swabs (33 of 39 [85%]) rather than in cerebrospinal fluid (10 of 41 [24%]). Magnetic resonance imaging revealed characteristic increased T2-weighted signal in the dorsal pons and spinal cord. All 4 patients with pulmonary edema (severe disease) demonstrated dorsal brainstem restricted diffusion (odds ratio, 2; 95% CI, 1-4; P = .001). Brainstem or motor dysfunction had resolved in 44 of 57 (77%) at 2 months and in 51 of 57 (90%) at 12 months. Focal paresis was evident in 23 of 57 (40%) at presentation and was the most common persisting clinical and functional problem at 12 months (observed in 5 of 6 patients), with 1 patient also requiring invasive ventilation. Patients initially seen with acute flaccid paralysis or pulmonary edema had significantly greater frequencies of motor dysfunction at follow-up compared with patients initially seen with other syndromes (odds ratio, 15; 95% CI, 3-79; P < .001). CONCLUSIONS AND RELEVANCE Enterovirus 71 may cause serious neurological disease in young patients. The distinct clinicoradiological syndromes, predominantly within the spinal cord and brainstem, enable rapid recognition within evolving outbreaks. Long-term functional neurological morbidity is associated with paresis linked to involvement of gray matter in the brainstem or spinal cord.

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Section: Discussionsupporting

confidence: 62%

Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children

et al. 2016

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“…2008; Jaramillo‐Gutierrez et al . 2013; Tsai et al 2014). It is important that primers must be frequently reviewed to take into account the rapid evolution and genomic changes of the circulating viruses.…”

Section: Discussionmentioning

confidence: 99%

“…Reverse transcription PCR (RT-PCR) and real-time reverse transcription PCR (qRT-PCR) assays targeting the 5 0 untranslated region (5 0 UTR) are largely used for the diagnosis of enteroviruses (Kottaridi et al 2004;Hymas et al 2008;Jaramillo-Gutierrez et al 2013;Tsai et al 2014). It is important that primers must be frequently reviewed to take into account the rapid evolution and genomic changes of the circulating viruses.…”

Section: Discussionmentioning

confidence: 99%

WarmStart colorimetric RT‐LAMP for the rapid, sensitive and specific detection of Enteroviruses A–D targeting the 5′UTR region

Daskou

Dimitriou

Alexopoulou

et al. 2020

J. Appl. Microbiol.

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Aims: The aim of the present study was to develop a colorimetric LAMP assay for the detection of enteroviruses belonging to species AD targeting the 5 0 untranslated region (5 0 UTR) of enteroviruses genome. Methods and Results: The RNA was converted to cDNA by the reverse transcriptase and then amplified via LAMP by the WarmStartâBst DNA polymerase, simultaneously in a single reaction tube, so we shortened the reaction time to 50 min. The sensitivity of the assay regarding Enterovirus B, C and D was determined to be 0Á30 CCID 50 assay À1 while the sensitivity for Enterovirus A was 3Á00 CCID 50 assay À1. The assay demonstrated high specificity and sensitivity for the detection of 45 reference strains of Enteroviruses AD and validated on 20 clinical isolates. Conclusions: This assay can be used as a diagnostic tool for the rapid, sensitive and specific detection of enteroviruses, easily implemented in small clinical and research laboratories since LAMP amplicons were visualized by colour changes eliminating the requirement for post-amplification processing steps. Significance and Impact of the Study: We developed a colorimetric assay ideal for field situations for the detection of enteroviruses, by targeting the 5 0 UTR. This assay demonstrated high specificity and sensitivity, based on its performance on 45 EV AD reference strains, on 20 EV B clinical isolates and on three non-enteroviral RNA viruses.

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“…Opsoclonus–myoclonus ataxia syndrome is considered as a rare manifestation of enterovirus 71 across all age groups, even though brain stem symptoms are identified as the most common form of encephalitis caused by this agent. 6,7 As far as the authors know, opsoclonus–myoclonus ataxia syndrome has been reported once in the pediatric literature to be associated with an enterovirus 71 infection, in a 1-year-old girl having favorable outcome. 3 There are limited evidence about the incidence of benign forms of opsoclonus–myoclonus ataxia syndrome.…”

Section: Discussionmentioning

confidence: 99%

Rapid Resolution of Enterovirus 71-Associated Opsoclonus Myoclonus Syndrome on Intravenous Immunoglobulin

Sahly

Gauquelin

Sébire

2017

Child Neurology Open

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Nonparaneoplastic opsoclonus–myoclonus ataxia syndrome is a rare neuroinflammatory condition featured by opsoclonus, myoclonus, ataxia, and cognitive behavioral disturbance. The authors report an observation of enterovirus 71-associated opsoclonus–myoclonus ataxia syndrome evolving toward full recovery on intravenous intravenous immunoglobulin (IG) treatment. Based on this case report, enterovirus 71 should be added to the list of infectious agents likely involved in opsoclonus–myoclonus ataxia syndrome, including the emerging subgroup of opsoclonus–myoclonus ataxia syndrome recovering without aggressive or prolonged immunosuppressive intervention. Further studies are mandatory to define the precise role, incidence, treatment, and outcome of enterovirus 71 and other infectious agents in benign forms of opsoclonus–myoclonus ataxia syndrome.

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Comparison of the Detection Rates of RT-PCR and Virus Culture Using a Combination of Specimens from Multiple Sites for Enterovirus-Associated Encephalomyelitis during Enterovirus 71 Epidemic

Cited by 11 publications

References 29 publications

Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children

Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children

WarmStart colorimetric RT‐LAMP for the rapid, sensitive and specific detection of Enteroviruses A–D targeting the 5′UTR region

Rapid Resolution of Enterovirus 71-Associated Opsoclonus Myoclonus Syndrome on Intravenous Immunoglobulin

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